MEDICARE: VALLEY HEALTH PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY40242	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2115852	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750379491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY HEALTH PHARMACY INC

Provider Business Mailing Address
First Line	:	12626 RIVERSIDE DR
Second Line	:	STE 100
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91607-3420
Country	:	US
Telephone Number	:	818-985-8151
Fax Number	:	818-985-7062

Provider Business Practice Location Address
First Line	:	12626 RIVERSIDE DR
Second Line	:	STE 100
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91607-3420
Country	:	US
Telephone Number	:	818-985-8151
Fax Number	:	818-985-7062

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHAWN ESMAILZADEH
Credential	:
Telephone Number	:	818-985-8151

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	03/15/2017

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Directions to “VALLEY HEALTH PHARMACY INC ” Practice Location

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